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| Fig. 21.5 A male patient with acne fulminans. Note the ulcerative lesions on the upper back. |
This rare systemic disease is seen predominately in young men. Its clinical features include fever, polyarthritis, leukocytosis, malaise, weight loss, anorexia, and severe, acute cystic and often ulcerative acne lesions. It occurs primarily on the upper trunk, but lesions may also be seen on the buttocks, proximal extremities, neck, and face (Fig. 21-5). The etiology is unknown, but it is thought to be immunologically mediated. It has been described in young men, particularly soldiers, who are introduced into a tropical environment where they are exposed to high humidity, temperature, and the friction of wearing a backpack. Like pyoderma faciale, it usually responds well to treatment with isotretinoin and oral prednisone.
